Gilead’s Stribild not covered by NY Medicaid; state also explores ‘prior auth’ status for AIDS drug

In response to AHF’s call for states to exclude Gilead’s new four-in-one AIDS tablet from their Medicaid program if is it is not price-neutral to Atripla, the New York State Department of Health says, “Stribild is not covered” and the state is reviewing the drug for “possible prior authorization requirements, to ensure the product is utilized in a medically appropriate and cost effective manner.” AHF continues to press Gilead to lower price of Stribild for Medicaid, Medicare, private insurers and other payors, following the agreement with the ADAP Crisis Task Force (ACTF), to lower the price of the drug for the nation’s hard-hit AIDS Drug Assistance Programs.

WASHINGTON (September 21, 2012) AIDS Healthcare Foundation (AHF) today reported that the New York State Department of Health’s Medicaid program does NOT cover Gilead Sciences’ expensive new AIDS drug Stribild, its new four-in-one treatment combination, which was approved by the Food and Drug Administration (FDA) in early September and then immediately priced by Gilead at $28,500 per patient, per year, Wholesale Acquisition Cost (WAC). That price was over 35% more than Atripla, the company’s best selling combination HIV/AIDS treatment, and made Stribild the highest priced first line combination AIDS therapy.

As a result and on the heels of a recent pricing agreement on Gilead’s new four-in-one AIDS tablet that was reached with the ADAP Crisis Task Force (ACTF) of the National Alliance of State & Territorial AIDS Directors (NASTAD) on behalf of the nation’s hard-hit network of AIDS Drug Assistance Programs (ADAPs), officials from AHF pressed Gilead to similarly lower the price for Medicaid, Medicare, private insurers and other payors that otherwise face Gilead’s steep price tag for the new medication. AHF officials also sent letters to private insurers and state health department directors nationwide urging that those programs exclude Stribild from their drug formularies if the drug was not priced price-neutral to Atripla. On September 14, 2012, Janet Zachary-Elkind, Deputy Director, Division of Program Development & Management for the New York State Department of Health responded via letter noting that, “At this time, Stribild is not covered by the Medicaid program,” and that the state is also, “…evaluating coverage options and possible prior authorization requirements to ensure the product is utilized in a medically appropriate and cost effective manner…”

“We asked the state arms of programs like Medicaid to exclude Stribild from their drug formularies or place the medication on ‘prior authorization’ status if Gilead does not make it price-neutral to that of their price for Atripla,” said Michael Weinstein, President of AIDS Healthcare Foundation. “The price of this drug was simply too high to start with and the price cut offered ADAP was not shared widely enough with other struggling insurance and assistance programs. As tax dollars pay for most of these drugs, we continue our call on Gilead to expand price concessions on Stribild to other programs including Medicaid, Medicare, private insurers and other payors.”

In its August 21 letter to the NY State Department of Health, AHF’s Weinstein wrote:

“While we expect this drug [Stribild] to be significantly more expensive than existing HIV medications, there is no justification for this; it does not provide a significant clinical benefit over these medications, and is less safe. Therefore, to safeguard the public health, we request that your state place the Quad on Prior Authorization in your ADAP and Medicaid programs. This will ensure the Quad [now called Stribild] is only prescribed to patients when there is a documented need for it, and also will help ensure access for people with HIV/AIDS to these safety net programs.”